Active NPI
Brandon Scott Backus Jackson
- Peer Specialist
- Seattle, WA
National Provider Identifier
1164952644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 515 3Rd Ave
Seattle, WA 98104-2304 - Phone
- (206) 464-1570
- NPI assigned
- Jun 15, 2017
- Last updated
- Nov 17, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG61445547 | WA | |
| Peer Specialist | 175T00000X | WA | Primary | |
| Counselor | 101Y00000X | |||
| Behavior Technician | 106S00000X |
Addresses
Primary practice location
515 3Rd Ave
Seattle, WA 98104-2304
Mailing address
515 3Rd Ave
Seattle, WA 98104-2304
Phone (206) 464-1570
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG61445547 | WA | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kitsap Mental Health Services | Past | Accepting new patients | |
| Behavior Services of the Rockies | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Bremerton, WA
- NPI 1033268008
-
- Community/Behavioral Health Agency
- Lafayette, CO
- NPI 1780129643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763337600000",
"number": "1164952644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 3RD AVE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981042304",
"telephone_number": "206-464-1570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 3RD AVE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981042304",
"telephone_number": "206-464-1570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACKUS JACKSON",
"first_name": "BRANDON",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-15",
"last_updated": "2025-11-17",
"certification_date": "2025-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG61445547",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "WA",
"license": null,
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.